Prognostic factors for survival differ according to CD4+ cell count among HIV-infected injection drug users: Pre-HAART and HAART eras

Noya Galai, David Vlahov, Joseph C. Bareta, Cunlin Wang, Sylvia Cohn, Timothy R. Sterling

Research output: Contribution to journalArticle

Abstract

To identify prognostic indicators of survival at different CD4+ cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). A community-recruited cohort of injection drug users followed semiannually from 1988 through 2000. Five partially overlapping subcohorts were defined by when participants first reached a CD4 cell level of 351 to 500, 201 to 350, 101 to 200, 51 to 100, or ≤50 cells/μL. Prognostic factors were measured at entry into each category. Kaplan-Meier survival estimates for HIV-related death and Cox regression models were constructed by CD4+ category. Among the 1030 HIV-infected IDUs, survival improved in the HAART-era with hazard ratios 0.42, 0.36, 0.24, 0.21, and 0.25, respectively, for CD4+ cell groups of 500 to 351, 350 to 201, 200 to 101, 100 to 51, and ≤50 cells/μL. Shorter survival was associated with prior hospitalization, AIDS, and sexually transmitted disease, with similar effects in the pre-HAART and HAART eras. For the lowest CD4+ cell level, prior sepsis or endocarditis, outpatient/emergency room visits, and alcohol use provide additional prognostic value. Survival among HIV-infected IDUs improved since the introduction of HAART, even though utilization of HAART was incomplete. Clinical and behavioral variables provided prognostic information about survival, including substance use indicators.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2005

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Keywords

  • AIDS
  • Drug injection
  • HIV
  • Highly active antiretroviral therapy
  • Mortality
  • Substance abuse

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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